ID

10011

Description

Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus NCT00550589 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3BC16E2A-1509-2256-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3BC16E2A-1509-2256-E044-0003BA3F9857

Keywords

  1. 8/26/12 8/26/12 -
  2. 3/14/15 3/14/15 - Martin Dugas
Uploaded on

March 14, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Anal Cancer NCT00550589 Registration - AMC-046 Enrollment Form (ENR) Segment A - 2685912v1.0

No Instruction available.

  1. StudyEvent: AMC-046 Enrollment Form (ENR) Segment A
    1. No Instruction available.
Header Module
Description

Header Module

Principal Investigator
Description

PrincipalInvestigatorName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C19924
UMLS CUI-1
C1521895
Age
Description

PatientAgeYearCount

Data type

integer

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ValueDomain
C29848
NCI Thesaurus ValueDomain-2
C25463
NCI Thesaurus Property
C25150
UMLS CUI-1
C0001779
Date Informed Consent Signed
Description

InformedConsentFormSignedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C16468
NCI Thesaurus Property
C25679
UMLS CUI-1
C2985782
Comments
Description

Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI-1
C0947611
Inclusion Criteria
Description

Inclusion Criteria

Alias
UMLS CUI-1
C1512693
Inclusion Criteria
Description

AIDSMalignancyConsortiumPatientInclusionClinicalTrialEligibilityCriteria046Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C16112
NCI Thesaurus Property-2
C25532
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C1512693
Exclusion Criteria
Description

Exclusion Criteria

Alias
UMLS CUI-1
C0680251
Exclusion Criteria
Description

AIDSMalignancyConsortiumPatientExclusionClinicalTrialEligibilityCriteria046Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C19707
NCI Thesaurus Property
C16112
NCI Thesaurus Property-2
C25370
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0680251

Similar models

No Instruction available.

  1. StudyEvent: AMC-046 Enrollment Form (ENR) Segment A
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
Principal Investigator
Item
Principal Investigator
text
C25191 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
C19924 (NCI Thesaurus ObjectClass)
C1521895 (UMLS CUI-1)
Age
Item
Age
integer
C16960 (NCI Thesaurus ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS CUI-1)
Informed Consent Date
Item
Date Informed Consent Signed
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C25679 (NCI Thesaurus Property)
C2985782 (UMLS CUI-1)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
Item Group
Inclusion Criteria
C1512693 (UMLS CUI-1)
Item
Inclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C16112 (NCI Thesaurus Property)
C25532 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
C1512693 (UMLS CUI-1)
Code List
Inclusion Criteria
CL Item
Date Of Informed Consent (Date of informed consent)
CL Item
Does The Investigator Believe That The Participant Is Capable Of Complying With The Protocol (Does the investigator believe that the participant is capable of complying with the protocol)
CL Item
Does The Participant Have Documentation Of Hiv-1 Infection By Any Licensed Elisa Test Kit And Confirmed By Western Blot At Any Time Prior To Study Entry (Does the participant have documentation of HIV-1 infection by any licensed ELISA test kit and confirmed by Western blot at any time prior to study entry)
CL Item
Does The Participant Have The Ability And Willingness To Give Informed Consent (Does the participant have the ability and willingness to give informed consent)
CL Item
If Female, And Of Childbearing Potential, Has The Participant Had A Negative Urine Pregnancy Test Within The Past 7 Days (If female, and of childbearing potential, has the participant had a negative urine pregnancy test within the past 7 days)
CL Item
Participant's Age (in Years) (Participant's age (in years))
CL Item
3 months (Does the participant have a life expectancy >)
Item Group
Exclusion Criteria
C0680251 (UMLS CUI-1)
Item
Exclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C16112 (NCI Thesaurus Property)
C25370 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0680251 (UMLS CUI-1)
Code List
Exclusion Criteria
CL Item
Does The Participant Have Concurrent Neoplasia Requiring Cytotoxic Therapy (Does the participant have concurrent neoplasia requiring cytotoxic therapy)
CL Item
Does The Participant Have Untreated Invasive Cancer Of The Lower Genital Tract (Does the participant have untreated invasive cancer of the lower genital tract)
CL Item
Is The Participant Pregnant Or Breast-feeding (Is the participant pregnant or breast-feeding)
CL Item
Is The Participant Receiving Corticosteroid Treatment, Other Than Replacement Doses (Is the participant receiving corticosteroid treatment, other than replacement doses)

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